Can independent adult practices learn from children’s pilots?

Health secretary Andrew Lansley announced two weeks ago that independent, GP-style social work practices will be piloted in adult services.

Some sector leaders have said the proposals, under which social workers would set up and run their own practices outside local authority control, could free practitioners from the burdens of bureaucracy, make services more responsive to need and give service users more choice.

But there are concerns about how smooth the model’s transition to adult services would be, given the relatively low uptake of similar opportunities in children’s services.

Lansley told this month’s National Children and Adult Services conference that the decision to pilot social work practices in England’s adult care sector followed a successful pilot in children’s services, launched by the Labour government in 2008 and expanded by the coalition in September.

The scheme is now halfway through a three-year pilot in five areas, and social workers taking part have reported increased motivation and stronger relationships with service users.

However, there have been significant challenges: just 17 of the 150 councils in England contacted the Department for Children, Schools and Families (now renamed the Department for Education) in 2008 to express interest in participating in the children’s pilot. A sixth pilot in Sandwell, West Midlands, collapsed after a vociferous campaign by the local Unison branch after concerns about privatisation and job losses.

“Clearly we’re going to learn from the children’s work,” said Jo Cleary, co-chair of the Association of Directors of Adult Social Services’ workforce development policy network.

Adass has entered talks with the Department of Health and is considering which client groups the pilots ought to prioritise.

Andrew Cozens, the Local Government Association group strategic lead on adult social care, said practices would work best where social workers offered therapeutic or case management support, as well as in safeguarding investigations.

“This seems to fit employers’ needs and social workers’ skills best,” he said.

Cozens was unconcerned by the low level of interest in children’s social work practices so far. “Adult social care is much more of a mixed economy, so different ways of doing things are quite common,” he said. For example, 81% of beds in English care homes are already in the private sector, according to Skills for Care.

According to Lansley, social work practices would put decision-making in the hands of social workers, giving them the flexibility to provide more personalised services.

Service user groups have broadly welcomed the idea.

“If disabled people are unhappy with the provision of social work by their local authority they will no longer be left with Hobson’s choice; they will have the opportunity to shop around,” said Mark Shrimpton, deputy chief executive of disability charity Radar.

But Caroline Bernard, deputy chief executive of older people’s charity Counsel and Care, said services would have to be built around service users and outcomes older people and their carers would be concerned about regulation and accountability of independent practices.

“Older people using these practices would need to know what the complaints procedures were so that they could complain without fear of reprisal,” she said.

Representative bodies for social workers are divided: the British Association of Social Workers believes the model could enable professionals to spend more time working with service users.

But Unison, which represents 40,000 social workers in the UK, is opposed to the idea and has accused the government of trying to break up social services.

“Outsourcing to practices is no panacea,” said Helga Pile, Unison’s national officer for social work. “Hiving off sections of the service would stand in the way of all social workers benefiting from sharing best practice.”

Adass president Richard Jones raised concerns that removing social workers from integrated teams could disrupt the growing links between health and social care.

However, he said this was not an inevitable consequence of forming social work practices, particularly in light of Lansley’s reassurance that the pilots will sit across health and social care.

The success of adult social work practices will depend then on several factors, including clarity about the role of social workers in adult social care and service user and employer engagement. For Cleary, employers will have to lead the way on social work practices – but there will have to be some meeting in the middle with social workers. That could provide the key to the pilots’ success.

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